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Biomedical subjects

O Jurkovicová

Publications and source records attributed to O Jurkovicová.

At least 19 recordsLinked to original sources
PubMed2003

[Effectiveness and safety of adenosine in the therapy and diagnosis of arrhythmias].

Adenosine is a drug with unique clinical and electrophysiological properties. Despite this, its use in Slovakia is rare. The decisive reason, besides its price, is the physicians fear of potential adverse effects and their limited knowledge regarding its clinical use. This study was aimed at analysis of the contribution of adenosine to the treatment and diagnostics of arrhythmias and evaluation of its safety. We studied the effect of adenosine in 62 patients. Adenosine terminated paroxysmal supraventricular tachycardia (PSVT) in 16 of 44 patients (36.4%) and in another 21 patients (47.7%) we revealed the type of unclear PSVT. We observed contribution to the diagnostics of wide QRS complex tachycardia in 3 of 6 patients (50.0%). Latent ventricular preexcitation was induced in 2 of 12 patients (16.7%). Subjective complaints after adenosine were frequent (at least 1 symptom in 80.6% patients), but all of them were of short duration and clinically not significant. We did not observe any relevant complication of adenosine. The average maximal RR interval after adenosine was 1.75 sec. We consider adenosine in adequately indicated patients with respect for its contraindications as highly effective drug in the treatment and diagnostics of specific arrhythmias.

Adenosine↗
PubMed2002

[Early diagnosis and reasons for not administering thrombolytic therapy in acute myocardial infarct].

In Slovakia we are lacking data on early (before examination of serum markers of myocardial necrosis) pertaining to thrombolytic treatment (TLL) which is inevitable in case of acute myocardial infarction (AIM) as well as data on the reasons why TLL is not implemented. This why the authors analyze the results of completed comprehensive project Audit concerned with diagnostic and therapeutic procedures in patients with acute coronary syndromes during the pre-hospital and hospital stage (AUDIT). The investigation was a perspective multi-centre study. Data were collected from 3123 patients with AIM in 66 departments (in 64 health institutions) during Sept. 16 1997 till Sept. 15 1998. The group included patients admitted within 96 hours after the development of complaints with the diagnosis or suspicion of AIM and discharged with the diagnosis of a first/repeated AIM. Early diagnosis of AIM was made in 1736 (55.6%) patients. In the AUDIT study TLL was assessed in 1074 (34.6%) patients. A marked difference between the number of candidates for TLL and the number of patients with TLL where TLL was implemented requires that in analyses of TLL in patients with AIM attention should be paid also to reasons why it was not implemented. The most frequent cause why TLL was nor implemented was late admission of the patient to hospital (in patients who attended hospital < 6 hours, TLL was not implemented in 48.5%, after admission between 6 and 12 hours in 70% and in patients admitted > 12 hours in as many as 90.8% patients), equivocal indication of TLL (in 29.9% patients) and contraindications (in 16.1% patients). The presented results are priority data on the early diagnosis of AIM and reasons why TLL was not implemented. It is part of data essential needed for elaboration of a (national) programme of better care (management) of patients with AIM taking into account also economic factors.

Contraindications↗
PubMed1996

[Adjuvant therapy in patients with acute myocardial infarct].

Besides the thrombolytic therapy several adjuvant therapeutic measures were identified which significantly improve the prognosis of patients with acute myocardial infarction (AMI). These measures include the treatment by means of acetylsalicylic acid (ASA), beta-blockers and ACE inhibitors. Early administration of ASA and beta-blockers are indicated in all patients with AMI who have no contraindications for this therapy. They are especially the patients with manifest heart failure or asymptomatic left ventricular dysfunction who benefit from ACE inhibitors. The effectivity of routine administration of other medicaments such as anticoagulants, nitrates, calcium channel blockers and magnesium, have not been convincingly proved. However, some selected patients with AMI can benefit from these medicaments. Intravenous administration of heparin is unambiguously justified only in thrombolysis with t-PA. Thrombolyses with streptokinase, urokinase, and anistreplase are justified only at high risk of thromboembolic complications. Their prevention and therapy include also the necessity to restrict the administration of pelentan. The use of nitrates is indicated in patients with AMI in case of sustaining stenocardia, arterial hypertension and manifest heart left ventricular failure. Until the definitive standpoint is gained regarding the effect of magnesium in patients with AIM, its administration remains especially indicated in cases of arterial hypertension, tachycardiac disturbances of the heart rhythm and states of assumed or proved hypomagnesiemia. In AMI cases when magnesium is used in order to protect the patient from reperfusion lesion, it must be administered prior to the reperfusion therapy. An intensive research in the field of therapeutical measures in patients with AMI still continues. It is certain that it will soon bring further knowledge which will in turn improve the prognosis and quality of life of patients with AMI. (Tab. 4, Ref. 133.)

Humans↗
PubMed1995

[Electrocardiographic Holter monitoring in patients with ventricular pre-excitation: possibilities of its uses and pitfalls].

Holter monitoring (HM) of the electrocardiogram (ECG) is used currently for the management of patients with ventricular preexcitation (PE). It makes it possible to detect inconstant PE which is considered a marker of a favourable clinical development. HM of ECG is not suitable for the detection of paroxysmal supraventricular tachycardias (PSVT) in patients with PE, as their presence is detected only exceptionally during HM. It can be used for the detection of other disorders of the cardiac rhythm than PSVT, in particular in supraventricular and ventricular extrasystoles (SVES and VES). Frequent SVES and VES detected during HM can as potential triggers of PSVT indicate a higher risk of these arrhythmias. HM is used for the objectivization of relatively frequent, sometimes quite polymorphous subjective complaints of patients with PE. Subjective data of these patients are very unreliable and from these data it is not possible to draw conclusions on the presence or absence of disorders of the cardiac rhythm. HM of ECG is not a suitable method for the evaluation of the effectiveness of medicamentous antiarrhythmic treatment of PSVT because of their considerable spontaneous variability. It may be, however, used partly for the evaluation of success of radiofrequency ablation treatment. Evaluation of long-term ambulatory ECG Holter tracings in patients with PE is more complicated and more time consuming than in subjects without PE. In any case it is essential that the record should be evaluated by an experienced physician with sufficient knowledge in arrhythmology.

Electrocardiography↗
PubMed1995

[Analysis of arrhythmias using Holter electrocardiographic monitoring in patients with ventricular preexcitation].

BACKGROUND: It is known that patients with preexcitation of ventricles (PE) have a predisposition to paroxysmal supraventricular tachyarrhythmias (PSVT). There is a relatively small amount of knowledge concerning the occurrence and clinical significance of other disturbances of the cardiac rhythm in these patients. OBJECTIVES: 1. To consider the possibility of utilization of Holter monitoring (HM) of electrocardiograms (ECG) in the detection of PSVT; 2. To find out the occurrence and evaluate the significance of other than paroxysmal tachycardias; 3. By means of correlation of subjective complaints with objectively documented arrhythmias to consider the extent, to which the subjective complaints are determined by disturbances of cardiac rhythm. METHODS: 24-hour HM ECG was performed under clinical conditions in 50 patients, 23 male and 27 female patients at the average age of 35 +/- 13 (ranging 15-17) years, with manifestant PE on ECG. 21 (42%) patients with documented PSVT and/or atrial paroxysmal fibrillation (APF) constituted a group with Wolff-Parkinson-White (WPW) syndrome. 29 (58%) patients without these arrhythmias were ranked among the group with WPW pattern. 22 (44%) patients had concomitant organic heart disease (OHD). Each long-term electrocardiographic ECG recording was judged in order to specify the occurrence of individual types of arrhythmias and to perform their quantitative analysis per 24 hours. Subjective complaints presented by patients during HM were correlated with the objectively documented arrhythmias. RESULTS: Arrhythmias were recorded in HM in 35 (70%) of patients with PE. Supraventricular premature beats (SVPBs) occurred in 32 (64%) and ventricular premature beats (VPBs) in 15 (32%) patients with PE. When comparing the patients with PE and OHD with subjects with PE without OHD, no statistical differences in the occurrence of SVPBs and VPBs as well as in numbers per 24 hours were discovered. PSVT were recorded by HM only in 2 patients, and AV reciprocating echoes in another patient with WPW syndrome. Short runs of atrial tachycardia occurred in 2 patients with WPW syndrome.

Adolescent↗
PubMed1993

Areas of slow conduction in atrial re-entrant tachycardia: a case report and review of the literature.

An electrophysiologic study of atrial tachycardia is presented. During tachycardia, transient entrainment and sinus rhythm, two patterns of persistent double potentials in the high right atrium and fragmented activity in the low atrial septum were observed. No activity was recorded from multiple areas of the right atrium with endocardial mapping during sinus rhythm. The observations suggest that persistent fragmented activity represents slow conduction within the circuit which could be orthodromically entrained. Persistent double potentials probably represent slow conduction orthodromically and/or antidromically activated outside the circuit. However, a wave front from pacing impulses travelling through this area could entrain the circuit.

Aged↗
PubMed1991

[The autonomic nervous system and disorders of heart rhythm. II].

The authors present in their review recent findings on the importance of the autonomous nervous system in disorders of the cardiac rhythm. They emphasize its modulating action in the development, maintenance and termination of many arrhythmias. Vegetative nervous influences may play a part in people without organic heart disease but are manifested more markedly above all at sites of previous damage. Mechanisms by which the autonomous nervous system influences the development and course of arrhythmias are very complicated and so far not completely elucidated. In addition to a generalized tonus of the sympathetic nerve and the parasympathetic nerve and their predominance a very important part is also played by regional and local changes of cardiac autonomous influences. Elucidation of mechanisms and indicators of vegetative factors influencing the heart creates prerequisites for their modulation by medication as well as other procedures.

Arrhythmias, Cardiac↗
PubMed1991

[The autonomic nervous system and disorders of heart rhythm. I].

The authors give an account of recent findings on the modulating action of the autonomous nervous system on electrophysiological properties of the heart and on mechanisms by which the vegetative nervous system participates in the development of disorders of the cardiac rhythm. In the development of arrhythmias, in particular the importance of the sympathetic nerve is emphasized. The relationship of stimulation of the sympathetic nerve and the development of arrhythmias may be conditioned: by its great activity, uneven distribution of sympathetic innervation and abnormal reaction of the damaged tissue to stimulation of the sympathetic nerve. Mechanisms by which stimulation of the sympathetic nerve may participate in the development of arrhythmias can be summarized as follows: the sympathetic nerve promotes the automation of natural and ectopic centres, shortens the refractory period of the conduction system, of the atrial and ventricular myocardium, increases the vulnerability of the atria and ventricles, reduces the fibrillation threshold; by induction of subsequent depolarizations it may induce (triggered activity); in the depolarized heart muscle it supports the development of slow forms of impulses and thus helps the development of reentry tachycardias; activation of the sympathetic nerve may cause hypokalaemia which is also an arrhythmogenic factor.

Arrhythmias, Cardiac↗
PubMed1990

[Biorhythms and disorders of heart rhythm].

Several factors are involved in the development of derangements of the rhythm of the heart. The role of some of them in the genesis of arrhythmias has not been fully elucidated as yet. It is still an enigma why some individuals develop derangements of the heart rhythm while others fail to do so under apparently equal conditions. Information on the value of biorhythms and their relevance to the development and course of arrhythmias is scarce and even controversial. Insight into these relationships and elucidation of the rhythmic nature of derangements of heart rhythm could be of great value in their prevention and treatment as well as in the prevention of sudden death.

Arrhythmias, Cardiac↗
PubMed1989

Use of selected quantitative parameters of the electric field of the heart in evaluating the presence and site of preexcitation.

Electrocardiographic methods play a decisive role in evaluation of the health condition of subjects with WPW pattern. The authors examined 54 patients with WPW pattern with different degrees of preexcitation. The presence of preexcitation and the localization of its focus was determined by surface electrocardiographic mapping using the original Czechoslovak computer equipment KARDIO-SMEP 01.0. The duration of ventricular activation was determined according to root mean square signals. By means of potential and temporo-spatial analysis of peak negative regions of instantaneous maps (in 2 ms intervals) they determined the duration of the period of proper preexcitation, of fusion of the two activation events, and of the end depolarization of the ventricles. In localizing the preexcitation focus they proceeded according to the criteria of Benson et al. (1982) with individual evaluation of quantitative preexcitation parameters of ECG maps and according to vector analysis of the delta wave. Quantitative and temporo-spatial evaluation of the mutual relationship of the two activation events in WPW pattern allows to establish reliably the presence, degree and focus localization of preexcitation even at a low degree of preexcitation and at a low-potential level of the preexcitation surface activity on ECG maps.

Adolescent↗
PubMed1987

Evaluation of the state of health of subjects with W-P-W syndrome.

Topical questions in evaluating the state of health in the least risk-exposed group of subjects with the W-P-W syndrome are dealt with: the recognition of preexcitation, the possibility of confusing the W-P-W syndrome with the postinfarction state, the occurrence of abnormal T waves after suppression of preexcitation, and the ECG dynamics after physical exercise. On the basis of ECG and normal results of non-invasive polygraphic examination (systole phase analysis--systolic time intervals) it is possible to divide the least-risk group of persons with preexcitation (with an otherwise normal heart and without paroxysmal tachycardia) into five subgroups (with growing risk) and to evaluate the ability of a person with preexcitation to engage in sports; to carry out military service etc. The mentioned non-invasive examinations are the basic prerequisites in every subject with the W-P-W syndrome and in symptomatic patients before more detailed electrophysiological examination.

Diagnosis, Differential↗
PubMed1985

Determination of the preexcitation focus in the W-P-W picture by isopotential body-surface mapping.

Experiences with the determination of the preexcitation focus in 13 patients with W-P-W syndrome aged 18-62 years are presented. The data of ECG mapping from the chest surface and the abdominal wall were processed by computer. For classification of the maps the criteria elaborated by Yamada et al., da Ambroggi et al., and Benson et al. were used. It was possible to determine on their basis the preexcitation focus in all examined subjects, although a reduced system of ECG leads was employed. Surface ECG mapping makes possible a more precise location of the preexcitation, which is of great clinical importance for the indication of surgical treatment, determination of prognosis and of working ability.

Adolescent↗
PubMedDate not supplied

[Ventricular arrhythmias and sudden cardiac death in acute myocardial infarct in the era of thrombolytics].

Sudden cardiac death (SCD) in the setting of acute myocardial infarction (AMI) remains an actual problem. There is a very close relationship between ventricular arrhythmias and SCD in AMI. Malignant ventricular arrhythmias, such as ventricular fibrillation and ventricular tachycardia are the major causes of SCD in coincidence with AMI. Frequent and complex ventricular arrhythmias are also important predictors of the risk of SCD in coincidence with and after AMI. In this article the authors emphasize the importance of the complexity of pathophysiological mechanisms responsible for the genesis of ventricular arrhythmias in coincidence with AMI. The necessity of taking into account the current knowledge about pathophysiology in prevention and therapy of separate forms of ventricular arrhythmias is also emphasized. The incidence and time course of ventricular arrhythmias and SCD in coincidence with AIM in prethrombolytic and thrombolytic periods is described. The importance of separate forms of ventricular arrhythmias in coincidence with AMI with regard to short and long-term prognoses is described. There are discussed also the possible mechanisms of thrombolytic and adjuvant therapies that affect the incidence and frequency of ventricular arrhythmias. The authors recommend the optimal therapy for each form of ventricular arrhythmia and the following management of patients with AMI. In the prevention and therapy of ventricular arrhythmias in the setting of AMI the authors emphasize the importance of early recanalization and prevention of re-occlusion of the infarction-related coronary artery. Great importance is attributed also to other adjuvant measures directed to the restriction of the size of infarction, myocardium protection, prevention and attenuation of remodelling of the left ventricle and thereby to the prevention of heart failure and attenuation of adverse effects of the sympathetic nervous system. An early administration of beta-blockers which favourable effect in and after AMI was documented with conclusive evidence is considered as one of the most important measures in prevention and therapy of malignant ventricular arrhythmias and SCD. The occurrence of malignant ventricular arrhythmias in the setting of heart failure and/or 24-48 hours after AMI should be an indication for aggressive management directed to arrhythmia (programmed ventricular stimulation, electrophysiologically guided pharmacologic or nonpharmacologic therapy) as well as to underlying coronary heart disease (coronary angiography and revascularization).

Arrhythmias, Cardiac↗
PubMedDate not supplied

[Anti-arrhythmia agents in the prevention of sudden cardiac death after myocardial infarct].

Heart rhythm disturbances represent one of the most important causes of cardiovascular mortality and, in particular, sudden cardiac arrhythmic death. The persistent actuality of arrhythmias is currently characterized by: 1) better knowledge of pathogenetic mechanisms of arrhythmias and their modulating factors, 2) improved diagnostic possibilities of arrhythmias, 3) availability of a large number of effective antiarrhythmics, as well as of nonpharmacologic therapeutic approaches too. Despite the narrowing spectrum of indications to pharmacologic treatment, both chronic and prophylactic antiarrhythmic therapies have nor become less complicated, but on the contrary they are even more problematic. The most actual and at the same time most controversial question of everyday clinical practice is the long-term antiarrhythmic prevention of sudden cardiac death. The author's aim is to review: 1) survey of studies which have influenced in a more decisive manner the management of patients after myocardial infarction and preventive antiarrhythmic therapy, 2) current antiarrhythmic prevention of sudden cardiac death, 3) the importance of programmed ventricular stimulation regarding the antiarrhythmic therapy and risk stratification in patients after myocardial infarction.

Anti-Arrhythmia Agents↗